Sandvik Elfrid Christine Smith, Aasarød Kristin Matre, Johnsen Gjermund, Hoff Dag Arne Lihaug, Kulseng Bård, Hyldmo Åsne Ask, Græslie Hallvard, Nymo Siren, Sandvik Jorunn, Fossmark Reidar
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway.
Department of Gastroenterology and Hepatology, St. Olav's University Hospital, 7006 Trondheim, Norway.
J Clin Med. 2022 Aug 21;11(16):4910. doi: 10.3390/jcm11164910.
Severe obesity is a strong risk factor for non-alcoholic fatty liver disease (NAFLD). Roux-en-Y gastric bypass (RYGB) surgery effectively induces weight loss, but few studies have described the long-term effects of RYGB on NAFLD-related fibrosis. Data from 220 patients with severe obesity operated by RYGB in Central Norway were analysed. Variables incorporated in NAFLD Fibrosis Score (NFS), Fibrosis-4 (FIB-4) index and anthropometric data were collected before surgery and a mean of 11.6 years postoperatively. FIB-4 > 1.3 or NFS > 0.675 were used as cut-off values for advanced fibrosis. Proportions with advanced fibrosis decreased from 24% to 14% assessed by FIB-4 and from 8.6% to 2.3% using NFS, with resolution rates of advanced fibrosis of 42% and 73%, respectively. The shift towards lower fibrosis categories was significant (NFS p < 0.0001; FIB-4 p = 0.002). NFS decreased from −1.32 (IQR −2.33−−0.39) to −1.71 (IQR −2.49−−0.95, p < 0.001) 11.6 years after surgery, whereas FIB-4 did not change: 0.81 (IQR 0.59−1.25) to 0.89 (IQR 0.69−1.16, p = 0.556). There were weak correlations between change in fibrosis scores and weight loss. In conclusion, the majority of patients with advanced fibrosis at baseline had improvement after 11.6 years. Factors associated with reduction in fibrosis were not identified.
重度肥胖是非酒精性脂肪性肝病（NAFLD）的一个重要危险因素。Roux-en-Y胃旁路术（RYGB）能有效诱导体重减轻，但很少有研究描述RYGB对NAFLD相关纤维化的长期影响。分析了挪威中部220例行RYGB手术的重度肥胖患者的数据。收集了手术前以及术后平均11.6年时的NAFLD纤维化评分（NFS）、Fibrosis-4（FIB-4）指数和人体测量数据中的变量。FIB-4>1.3或NFS>0.675被用作高级别纤维化的临界值。通过FIB-4评估，高级别纤维化的比例从24%降至14%，使用NFS评估则从8.6%降至2.3%，高级别纤维化的缓解率分别为42%和73%。向较低纤维化类别的转变具有显著性（NFS p<0.0001；FIB-4 p = 0.002）。术后11.6年，NFS从-1.32（四分位间距-2.33--0.39）降至-1.71（四分位间距-2.49--0.95，p<0.001），而FIB-4没有变化：从0.81（四分位间距0.59-1.25）变为0.89（四分位间距0.69-1.16，p = 0.556）。纤维化评分变化与体重减轻之间存在弱相关性。总之，大多数基线时患有高级别纤维化的患者在11.6年后病情有所改善。未确定与纤维化减轻相关的因素。
